Dr. Ameen, ENT Specialist in Kuala Lumpur

Today, we will discuss the risks associated with PITA and its suitability as a daycare procedure. What is partial tonsillectomy, and what are its indications?

Partial tonsillectomy (PT) is one of the most common operations in pediatric otolaryngology. It is variously described as tonsillotomy, intra-capsular tonsillectomy and subcapsular tonsillectomy.

All terms refer to the technique which involves removing most of the tonsil lymphoid tissue, while sparing the capsule. The remaining lymphoid tissue and capsule serve as a protective sheet and as a biological dressing over the pharyngeal muscle layer and underlying vessels, to improve pain and decrease swelling.

They recommend tonsillectomy for children with sleep disordered breathing (SDB) or obstructive sleep apnea (OSA). However, they did not include information regarding PT, even though this was gaining popularity among otolaryngologists worldwide and is used primarily for treating SDB/OSA.

Is a PITA procedure safe to be performed as a daycare case? Let’s delve into this study.

Abstract

Background
Partial Tonsillectomy (PT) is an alternative method to treat sleep disordered breathing (SDB) and/or obstructive sleep apnea (OSA). The current guidelines do not differentiate it from traditional tonsillectomy. Thus, children younger than 3 years old undergoing PT are admitted for surveillance similar to traditional tonsillectomy due to possible postoperative complications. The aim of this study is to assess the risks of PT in children 3 years old and younger, compared to older children.

Methods
Children underwent inpatient partial tonsillectomy and/or adenoidectomy, due to SDB/OSA, from 2018 to 2020. A special protocol was designed, including follow-up at 2-, 4-, 6-, 8- and 24-h after surgery. Variables analyzed included visual analogue pain score, oral intake, oxygen saturation, pulse rate, postoperative hemorrhage, urine output, temperature, analgesics and fluid administration. Furthermore, major interventions were recorded. Comparison of all variables between children younger than 3 years old with older children was performed.

Results
Ninety-two children were included; mean age of the whole cohort was 44.5 ± 21.9 months. Thirty-five (38%) children were 3-years old or younger and n = 57 (62%) were older than 3 years old, with no significant statistical difference in sex (p = 0.22). Mean age in the younger group was 25.7 ± 6.9 months, and 56.1 ± 20.1 months in the older group. In total we had 7 children with post-operative complications; 4 with fever, 3 with low intake. There were no major interventions recorded in either group. The complications were more common in the older group (n = 5) than the younger group (n = 2) without a statistical significance (p = 0.59). There were no differences in VAS, use of painkillers, oral intake, urine output, oxygen saturation and tachycardia among the two groups.

Conclusion
This study supports that children undergoing ambulatory PT may be at low risk of complications, regardless of age.